As congressional Republicans try to pass an unpopular plan that would roll back the Affordable Care Act (ACA) and cause an estimated 22 million Americans to lose their health insurance, a House bill to expand the publicly-funded Medicare program from just senior citizens to every American is picking up record support — and not just among the usual progressive suspects but also from conservative Southern Democrats.

First introduced in 2003 by Rep. John Conyers, a Michigan Democrat and Congress’s longest-serving member, the Expanded and Improved Medicare for All Act (HR 676) would provide every US resident with free medically necessary care including primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services and vision care.

It would be paid for with existing health care funds and by raising personal income taxes on the top 5 percent of income earners, instituting a progressive excise tax on payroll and self-employment income, and taxing unearned income and stock and bond transactions. US Sen. Bernie Sanders (I-Vermont), who advocated for single-payer insurance during his unsuccessful 2016 presidential run, has said he will introduce similar legislation in the Senate following the vote on the Republican ACA rollback plan.

Medicare for All has the backing of numerous medical groups such as the American Nurses Association, the American Public Health Association and the American Medical Association’s student branch. Other groups that have endorsed it include the Consumer Federation of America, the League of Women Voters and the US Conference of Mayors.

That surge in support has come amid a public debate over health care that’s shifted the politics leftward. For example, a recent national survey by the Pew Research Center found that 60 percent of Americans now say the federal government should be responsible for ensuring health care coverage for all and 33 percent favor a single-payer approach like Medicare for All — up by 12 points since 2014 and 5 points just since January.

“I have never seen more enthusiasm and energy behind this issue than what I’m seeing today,” Conyers said in a statement. “I will keep introducing this bill as long as it takes because access to health care — not just health insurance, but quality, affordable care — is a universal right, not a privilege for those who can afford it.”

Blue Dogs Sign On

The Medicare for All bill has long had strong support from Conyers’ fellow Congressional Black Caucus members and House progressives, and it continues to pick up new support among liberal and centrist Democrats.

For example, Rep. David Price of North Carolina’s 4th Congressional District — a safely Democratic district that includes parts of Raleigh and Durham and all of Chapel Hill — signed on as a cosponsor for the first time on April 3. That was less than a month after he told a constituent at a local town hall meeting where health care was a leading concern that now was not the time to press the single-payer option. Price spokesperson Lawrence Kluttz explained the lawmaker’s change of heart.

“Congressman Price co-sponsored the so-called Medicare for All bill in direct response to a request from his constituents; he also feels that it’s important to signal his support for universal health care,” Kluttz told Facing South. However, he noted, Price doesn’t believe the proposal is feasible under GOP leadership and intends to focus on defending the protections of the ACA.

Though Medicare for All might not be feasible right now, it’s starting to win over a tough crowd: conservative Democrats from red states in the South.

Of the bill’s 113 current cosponsors, four are members of the conservative Democrats’ Blue Dog Coalition. Two of them — Mike Thompson and Lou Correa — represent districts in California, which has been leading the state-level push for a single-payer health program, though the proposal was blocked recently by the Democratic leadership.

The other two Blue Dogs cosponsoring Medicare for All are from the South. Vicente Gonzalez, who was elected last year to represent South Texas’ 15th Congressional District, signed on on April 17. Jim Cooper, who has represented Middle Tennessee’s 5th Congressional District since 2003 and who served its 4th Congressional District from 1983 to 1995, signed on on April 25. Both seats are considered safely Democratic.

Neither Gonzalez nor Cooper released official statements announcing their cosponsorship. A spokesperson for Gonzalez’s office said on background that the congressman signed on after hearing concerns about health care from older constituents, while Cooper’s office did not immediately respond to a request for comment. But conditions in their districts and states, both of which declined to expand Medicaid under the ACA, offer clues as to why they might see a need for Medicare for All.

Gonzalez’s district stretches from east of San Antonio south to the Mexican border and is 80 percent Hispanic. Between 2013 and 2015, with the ACA in force, the number of uninsured residents there dropped by 13 percent, but 205,000 still lacked health coverage, according to the State Health Access Data Assistance Center (SHADAC). The Republican health care plan would result in an additional 105,000 district residents losing coverage, an analysis by the Center for American Progress (CAP) found.

The population of Cooper’s district, which includes Nashville and communities west of the city, is over 23 percent black compared to 17 percent of the state overall. The number of uninsured district residents dropped by over 22 percent between 2013 and 2015, but more than 92,000 still lacked health insurance, according to SHADAC. Under the current Republican health care proposal, the number of uninsured in the district could grow by 79,600, CAP found.

Cooper, who has called the GOP health care bill “a national tragedy,” has not always been a progressive on health care. In 1992, he was the co-author of a bipartisan health care reform plan that excluded employer mandates compelling universal coverage. Hillary Clinton, who at the time was leading a White House health care reform initiative as First Lady, strongly opposed the measure.

GOP Goes on the Attack

Other Southern Democrats who’ve signed on to the Medicare for All bill for the first time this year are Kathy Castor, Ted Deutch, Al Lawson and Darren Soto of Florida; Bennie Thompson of Mississippi; GK Butterfield of North Carolina; and Gene Green and Marc Veasey of Texas.

They join veteran Southern cosponsors Alcee Hastings and Frederica Wilson of Florida, Hank Johnson and John Lewis of Georgia, John Yarmuth of Kentucky, Alma Adams of North Carolina, Jim Clyburn of South Carolina, Steve Cohen of Tennessee, Al Green and Sheila Jackson Lee of Texas and Bobby Scott of Virginia.

Physicians for a National Health Plan (PNHP), which advocates for the Medicare for All proposal, has unveiled a list of likely and potential cosponsors. It includes two Blue Dog Democrats from the South, both representing Georgia: Sanford Bishop, who has served southwest Georgia’s 2nd Congressional District since 1993, and David Scott, who has represented suburban Atlanta’s 13th Congressional District since 2003.

The other likely Democratic cosponsors as identified by PNHP are Terri Sewell of Alabama, Lois Frankel of Florida, Cedric Richmond of Louisiana and Eddie Bernice Johnson of Texas.

PNHP also identifies 19 potential Republican cosponsors, four of whom are from the South: Carlos Curbelo and Ileana Ros-Lehtinen of Florida, Will Hurd of Texas and Barbara Comstock of Virginia. While Curbelo voted for the House ACA repeal bill, the other three voted against it.

For Comstock, for example, taking a more progressive stance on health care could be a political survival strategy in Northern Virginia’s increasingly moderate 10th Congressional District, where Clinton won 51 percent of the vote in last year’s presidential race. While the possibility of GOP lawmakers embracing Medicare for All might seem remote, another recent poll found that 40 percent of Trump voters and 46 percent of Republican voters overall support expanding Medicare to all Americans.

As the single-payer approach has gained popularity, the GOP has taken steps to discredit it. Earlier this month, the party’s Senate campaign committee launched Web ads against the 10 Senate Democrats up for re-election in states that Trump won, warning of “government health care” if they win. And the National Republican Congressional Committee has promoted a CNN interview in which Randy Bryce, an ironworker who’s challenging Speaker Paul Ryan for his Wisconsin House seat, was pressed about his support for a single-payer plan and the taxes it would require; the interviewer did not mention that Medicare for All would actually save money for 95 percent of US households.

In the meantime, the Republican Party continues to struggle to win support for its own health care plan. Senate Majority Leader Mitch McConnell of Kentucky was unsuccessful in his efforts to take a vote before the July 4 recess, allowing time for concerned voters to reach out to their representatives at home. While he can afford to lose only two of his 52 Republican senators, 10 GOP senators have said publicly that they oppose the bill in its current form. They include Rand Paul of Kentucky, Ted Cruz of Texas and Shelley Moore Capito of West Virginia.

Sue is editorial director at the Institute for Southern Studies, which she joined in November 2005 as director of the Institute's Gulf Coast Reconstruction Watch, a project to document and investigate the post-Katrina recovery. A former staff writer for the Raleigh News & Observer and Independent Weekly (Durham, North Carolina), Sue directs and regularly contributes to the Institute's online magazine, Facing South, with a focus on energy and environmental issues. Sue is the author or coauthor of five Institute reports, including "Faith in the Gulf" (August/September 2008), "Hurricane Katrina and the Guiding Principles on Internal Displacement" (January 2008) and "Blueprint for Gulf Renewal" (August/September 2007). Sue holds a Master's degree in journalism from New York University.

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